$4.3M Award in Medicare Fraud Lawsuit Upheld

The sentences for two former employees of a home healthcare company, along with a $4.3 million verdict, were upheld by a higher court over allegations of Medicare fraud.

Medicare Fraud Lawsuit Outcome Upheld

Two employees of Medicall Physicians Group Ltd., Rick Brown and Mary Talaga, had been sentenced to 87 and 45 months in prison for their part in a scheme to defraud the federal government by overbilling Medicare. The owner of the healthcare company pled guilty in the Medicare fraud lawsuit, but the two employees maintained their innocence. They were found guilty, but appealed arguing the district court had incorrectly calculated their sentences.

The Seventh Circuit disagreed with the employees, upholding their years-long sentences, along with the $4.3 million verdict in the Medicare fraud lawsuit.

“With respect to Mr. Brown, the district court properly calculated the guidelines range, recognized its ability to depart from the Guidelines, considered all of the … factors, and imposed a sentence that was thirty-four months below the guidelines range — a sentence that the court characterized as ‘a significant downward variance,’” noted the panel in their opinion over the matter. “The court noted that four factors prevented it from departing further: the duration of the scheme, the amount of the fraud, the need for general deterrence, and Mr. Brown’s failure to accept responsibility.”

The opinion acknowledged Brown’s argument that the length of his sentence would not act to deter others from committing Medicare fraud; however, they pointed out the district court’s determination otherwise that Medicare fraud is prevalent in the home healthcare industry.

“The district court was entitled to conclude that, given that health-care fraud is widespread and that therefore there is a lower likelihood of getting caught, a serious penalty was necessary to ensure deterrence,” noted the opinion. “At sentencing, the Government specifically brought to the district court’s attention that ‘the Medicare program has imposed a moratorium on additional companies joining the program to provide home healthcare services because it is — the fraud in the area is so prevalent.’”

The other employee, Mary Talaga, asserted that she do not have enough knowledge of the scheme to support her 45 month sentence; however, evidence in the Medicare fraud lawsuit showed that she had years of experience in the industry and should have known what was happening.

“Ms. Talaga was an experienced Medicare biller when she arrived at Medicall,” pointed out the opinion in the Medicare fraud lawsuit. “There was testimony that she performed her work quickly, that she knew how to re-code rejected claims so that they would be paid, and that she trained other staff. The district court reasonably concluded that, based on Ms. Talaga’s training and experience, she would have recognized … that these claims were fraudulent.”

Medicare and Medicaid fraud deprives these important health care programs for the most vulnerable and costs American taxpayers money. If you work in healthcare and are concerned about Medicare or Medicaid fraud, contact the experienced attorneys at Bradley/Grombacher.

The Medicare Fraud Lawsuits are U.S. v. Rick E. Brown and U.S. v. Mary C. Talaga, Case No. 15-3117 and 15-3261, in the U.S. Court of Appeals for the Seventh Circuit.

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.